<?php require "header.php"; ?>

<form action="input.php" method="post">
    <fieldset>
        <legend>Owner Information</legend>
        <label for="firstname">First Name:</label><input type="text" name="firstname" id="firstname" tabindex="1" />
        <label for="lastname">Last Name:</label><input type="text" name="lastname" id="lastname" tabindex="2" /><p/>
        <label for="address">Street Address:</label><input type="text" name="address" id="address" tabindex="3" size="53" /><p/>
        <label for="city">City:</label><input type="text" name="city" id="city" tabindex="4" size="36" />
        <label for="state">State:</label><select name="state" id="state" tabindex="5">
                <option value="AL">AL</option>
                <option value="AK">AK</option>
                <option value="AZ">AZ</option>
                <option value="AR">AR</option>
                <option value="CA">CA</option>
                <option value="CO">CO</option>
                <option value="CT">CT</option>
                <option value="DE">DE</option>
                <option value="DC">DC</option>
                <option value="FL">FL</option>
                <option value="GA">GA</option>
                <option value="HI">HI</option>
                <option value="ID">ID</option>
                <option value="IL">IL</option>
                <option value="IN">IN</option>
                <option value="IA">IA</option>
                <option value="KS">KS</option>
                <option value="KY">KY</option>
                <option value="LA">LA</option>
                <option value="ME">ME</option>
                <option value="MD">MD</option>
                <option value="MA">MA</option>
                <option value="MI">MI</option>
                <option value="MN">MN</option>
                <option value="MS">MS</option>
                <option value="MO">MO</option>
                <option value="MT">MT</option>
                <option value="NE">NE</option>
                <option value="NV">NV</option>
                <option value="NH">NH</option>
                <option value="NJ">NJ</option>
                <option value="NM">NM</option>
                <option value="NY">NY</option>
                <option value="NC">NC</option>
                <option value="ND">ND</option>
                <option value="OH">OH</option>
                <option value="OK">OK</option>
                <option value="OR">OR</option>
                <option value="PA">PA</option>
                <option value="RI">RI</option>
                <option value="SC">SC</option>
                <option value="SD">SD</option>
                <option value="TN">TN</option>
                <option value="TX">TX</option>
                <option value="UT">UT</option>
                <option value="VT">VT</option>
                <option value="VA">VA</option>
                <option value="WA">WA</option>
                <option value="WV">WV</option>
                <option value="WI">WI</option>
                <option value="WY">WY</option>
        </select>
        <label for="zip">Zip:</label><input type="text" name="zip" id="zip" maxlength="5" size="5" tabindex="6"/><p/>
        <label for="phoneHome">Phone(H):</label><input type="text" size="14" name="phoneHome" id="phoneHome" tabindex="7"/>
        <label for="phoneCell">Phone(C):</label><input type="text" size="14" name="phoneCell" id="phoneCell" tabindex="8"/>
        <label for="phoneWork">Phone(W):</label><input type="text" size="14" name="phoneWork" id="phoneWork" tabindex="9"/><p/>
        <label for="notes" class="topalign">Notes:</label><textarea id="notes" name="notes" tabindex="10" cols="61" rows="3"></textarea><p/>

        <button type="button" name="submit" id="submit" tabindex="11">Submit &raquo;</button>
    </fieldset>
</form>

<?php require "footer.php"; ?>